| NPI | 1295749851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: LA MD.08792R) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: LA MD.08792R) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0050358) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2024-09-25 |